Substance Use

• needing more of the substance to get the same effect
• finding it difficult to cut down or stop, even when wanting to
• withdrawal symptoms such as shaking, sweating, sickness, agitation or difficulty sleeping
• using in order to feel normal, or to avoid withdrawal
• blackouts, memory gaps or losing hours of the day
• changes in mood, sleep, appetite, weight or behaviour
• anxiety, paranoia, hallucinations or thoughts of suicide or self-harm
• problems at work or school, money worries, rent arrears or relationship breakdown
• borrowing money, secrecy, or taking risks in order to obtain substances
• injuries, wounds, skin or chest infections, or physical health getting worse
• driving, working in a safety-critical role, or caring for children while impaired
• continuing to use despite serious consequences already happening

One sign on its own does not prove dependence. But if you recognise several of these — or if someone who cares about you has raised a concern — it is worth talking to a GP or a local drug and alcohol service. Nothing bad happens simply for asking a question.^{[4]NHS — alcohol misuse}

Opioids include heroin and medicines such as methadone, morphine, buprenorphine and some strong painkillers. Overdoses in the UK may also involve synthetic opioids, including fentanyl and nitazenes, which can be present in substances sold as something else entirely.

• Opioid overdose typically suppresses breathing. Slow, shallow, noisy or absent breathing is the key danger sign.
• Naloxone is a medicine that temporarily reverses the effects of an opioid overdose.
• In an emergency, anyone may use naloxone that is available to save a life.^[10]GOV.UK
• Take-home naloxone can be supplied by drug treatment services and other services authorised locally. Arrangements vary between areas and across the four UK nations.
• Family members and friends can often be given naloxone and brief training too — it is worth asking.
• Ask your local drug and alcohol service where naloxone is available near you, and how to be shown how to use it.
• Always call 999, even after naloxone has been given. Naloxone wears off before the opioid does, so the person can stop breathing properly again.
• Follow the training you were given and the instructions supplied with the product. We do not publish doses on this page.

Most drug-related deaths in the UK involve more than one substance. Combinations are far less predictable than any single substance on its own.

• alcohol taken with opioids or with other sedatives
• opioids taken with benzodiazepines, pregabalin or gabapentin
• cocaine or other stimulants taken with alcohol, or with other stimulants
• unknown tablets, powders, or counterfeit medicines bought online or from other people
• mixing prescribed medicine with non-prescribed substances
• dehydration, overheating and heart strain, particularly with stimulants
• impaired judgement leading to accidents, falls, drowning, assault or unsafe driving
• reduced tolerance after any break from using
• never use someone else’s prescription medicine — it is not prescribed for your body, your health conditions or your other medicines
• never share needles or any other injecting equipment, because of the risk of HIV, hepatitis B and C, and serious infections
• local needle-and-syringe services provide sterile equipment, safe disposal, testing for blood-borne viruses, wound care advice and a route into treatment when someone is ready

In most parts of the UK you can contact your local drug and alcohol service directly without waiting for a GP referral, although arrangements vary by area. Services are normally free and confidential.^[1]NHS

An assessment is a conversation, not a test. Staff do this every day and they are not there to judge you. You may be asked about:

• which substances you use and how often
• prescribed and over-the-counter medicines you take
• alcohol use, including at times you may not think of as drinking sessions
• withdrawal symptoms and any previous overdoses
• physical health, including injuries, infections and long-term conditions
• mental health, including low mood, anxiety and thoughts of suicide or self-harm
• pregnancy, or the possibility of pregnancy
• housing, money, relationships and caring responsibilities
• any risks to children or vulnerable adults
• what you want to change, and what your goals are

Being honest helps professionals give you safer care — particularly about everything you are taking, because combinations affect what can be prescribed safely.

About confidentiality: services normally keep your information private and will explain what they record. However, they may need to share information where there is a serious and immediate risk to someone’s safety, or a safeguarding concern about a child or vulnerable adult. Nobody can promise absolute confidentiality, but sharing is not automatic and staff should explain it to you clearly. Ask about the service’s confidentiality policy at the start if it worries you.

• A young person asking for help should never be shamed or threatened. Being able to ask is the safest thing they can do.
• Encourage them to speak to a parent or carer, a GP, the school safeguarding lead, a youth worker, or a specialist young person’s substance service.
• Call 999 for overdose, unconsciousness, breathing problems, seizure, collapse or any immediate danger.
• Safeguarding should be explained calmly: adults have a duty to keep young people safe, which sometimes means involving others — this is about protection, not punishment.
• FRANK provides confidential information for young people, and Childline offers free confidential support for under-19s.
• Adult treatment arrangements do not automatically apply to children and young people; services for under-18s are designed differently.^{[18]NICE NG64}

• Do not suddenly stop dependent drinking, opioids, benzodiazepines or prescribed medicines without medical advice — sudden withdrawal can be harmful to both parent and baby.
• Contact a GP, midwife, maternity service or local drug and alcohol service as soon as you can. Earlier contact means more options.
• Professionals can plan safer treatment and monitoring for you and your baby together.
• Urgent symptoms, suspected overdose or severe withdrawal need emergency help — call 999, or NHS 111 for urgent advice that is not life-threatening.
• You should be supported, not blamed. Maternity and substance services work with people in this situation regularly.

• Choose a calm, private time to talk, when neither of you is rushed or intoxicated.
• Describe what you have noticed, using plain facts rather than insults or accusations.
• Listen more than you speak, and encourage professional help without issuing ultimatums.
• Offer to help find the local service, make the call, or go with them to an appointment.
• Learn the overdose signs, and ask about naloxone if opioids may be involved.
• Do not give money where it creates an immediate safety risk.
• Protect children and vulnerable adults, and keep medicines and finances secure.
• Call 999 whenever there is immediate danger.
• Get support for yourself too. Carers and relatives can access help even when the person they care about is not ready for treatment.^[6]NHS
• Do not try to physically restrain someone who is agitated unless it is necessary to prevent immediate harm and it is safe to do so. Your safety matters — step back and call 999 if needed.

Waiting lists, uncertainty or simply not being ready yet should not cost anybody their life. These are the safety points UK services consistently emphasise.

• Do not use alone.
• Make sure someone knows where you are and can call for help.
• Carry naloxone where opioids may be involved, and make sure people around you know where it is and how to use it.
• Avoid mixing substances, especially opioids with alcohol or other sedatives.
• Remember that tolerance may be much lower after any break — after hospital, prison, residential treatment or simply a few days without using.
• Avoid unknown tablets, powders and counterfeit medicines bought from people or online sellers.
• Use sterile equipment from a needle-and-syringe service, and never share it with anyone.
• Only rely on drug-checking or drug-alert information where an official local service provides it.
• Seek urgent help for infections, wounds that are not healing, chest pain, breathing problems, confusion or any unusual symptoms.
• Keep prescribed medicines locked away and out of reach of children.

Across the UK: the NHS service finders above cover England. Elsewhere, start here:

In a life-threatening emergency, always call 999.